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精准癌症医学:概念、当前实践和未来发展。

Precision cancer medicine: Concepts, current practice, and future developments.

机构信息

Department of Clinical Genetics, Pathology and Molecular Diagnostics, Office for Medical Services, Region Skåne, Lund, Sweden.

Division of Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.

出版信息

J Intern Med. 2023 Oct;294(4):455-481. doi: 10.1111/joim.13709. Epub 2023 Aug 28.

Abstract

Precision cancer medicine is a multidisciplinary team effort that requires involvement and commitment of many stakeholders including the society at large. Building on the success of significant advances in precision therapy for oncological patients over the last two decades, future developments will be significantly shaped by improvements in scalable molecular diagnostics in which increasingly complex multilayered datasets require transformation into clinically useful information guiding patient management at fast turnaround times. Adaptive profiling strategies involving tissue- and liquid-based testing that account for the immense plasticity of cancer during the patient's journey and also include early detection approaches are already finding their way into clinical routine and will become paramount. A second major driver is the development of smart clinical trials and trial concepts which, complemented by real-world evidence, rapidly broaden the spectrum of therapeutic options. Tight coordination with regulatory agencies and health technology assessment bodies is crucial in this context. Multicentric networks operating nationally and internationally are key in implementing precision oncology in clinical practice and support developing and improving the ecosystem and framework needed to turn invocation into benefits for patients. The review provides an overview of the diagnostic tools, innovative clinical studies, and collaborative efforts needed to realize precision cancer medicine.

摘要

精准癌症医学是一项多学科团队的努力,需要包括广大社会在内的众多利益相关者的参与和承诺。在过去二十年中,肿瘤患者精准治疗取得重大进展的基础上,未来的发展将受到可扩展分子诊断方面的改进显著影响,其中日益复杂的多层数据集需要转化为指导患者管理的临床有用信息,以实现快速周转。涉及组织和液体检测的自适应分析策略,考虑到患者治疗过程中癌症的巨大可塑性,并包括早期检测方法,已经开始进入临床常规,并将变得至关重要。第二个主要驱动因素是智能临床试验和试验概念的发展,这些试验概念与真实世界的证据相结合,迅速扩大了治疗选择的范围。在这方面,与监管机构和卫生技术评估机构的紧密协调至关重要。在国家和国际层面运作的多中心网络是将精准肿瘤学应用于临床实践的关键,并支持开发和改进为患者带来利益所需的生态系统和框架。本综述概述了实现精准癌症医学所需的诊断工具、创新临床研究和合作努力。

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